Mortality impact of low CAC density predominantly occurs in early atherosclerosis: explainable ML in the CAC consortiumOriginal TOC summary: We used SHAP, an explainable machine learning (ML) technique, to determine the risk predictive value and age interaction of coronary artery calcium (CAC) characteristics among 63,215 asymptomatic patients in the CAC consortium. The addition of CAC density and number of calcified vessels to an ML model with clinical characteristics + CAC did not improve prediction for all-cause mortality (p = 0.23), but did improve for cardiovascular mortality (p = 0.03). Lower CAC density increased mortality, particularly very low CAC density ≤0.75, which occurred predominantly in CAC1-100. Explainable ML should be applied in clinical research for transparent predictive modeling.
Higher coronary artery calcium score is associated with increased risk of atrial fibrillation recurrence after catheter ablationCoronary artery calcium score (CACS) is associated with an increased risk of atrial fibrillation (AF) development, but scarce data are available regarding the impact on AF recurrence. This study aims to assess the impact of CACS on AF recurrence following catheter ablation.
Computed tomography imaging for subclinical leaflet thrombosis following surgical and transcatheter aortic valve replacementSubclinical leaflet thrombosis (LT) may occur following surgical and transcatheter aortic valve replacement. Computed tomography (CT) has become an established imaging modality to diagnose subclinical LT following bioprosthetic aortic valve replacement. Even so, there is a limited (but growing) experience in utilizing CT imaging for this indication. This review emphasizes a systematic approach to acquiring and analysing CT imaging for subclinical LT, highlighting evidence surrounding clinical sequelae of subclinical LT and anti-thrombotic implications following diagnosis.
The effect of patient and imaging characteristics on coronary CT angiography assessed pericoronary adipose tissue attenuation and gradientCoronary CT angiography (CCTA) pericoronary adipose tissue (PCAT) markers are promising indicators of inflammation.
Implications of computed tomography reconstruction algorithms on coronary atheroma quantification: Comparison with intravascular ultrasoundAdvances in coronary computed tomography angiography (CCTA) reconstruction algorithms are expected to enhance the accuracy of CCTA plaque quantification. We aim to evaluate different CCTA reconstruction approaches in assessing vessel characteristics in coronary atheroma using intravascular ultrasound (IVUS) as the reference standard.
Association of left ventricular diastolic function with coronary artery calcium score: A Project Baseline Health StudyCoronary artery calcium (CAC) and left ventricular diastolic dysfunction (LVDD) are strong predictors of cardiovascular events and share common risk factors. However, their independent association remains unclear.
Follow-up assessment of myocardial calcification secondary to fulminant myocarditis with computed tomographyA 16-year-old man underwent venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy due to hemodynamic collapse caused by viral fulminant myocarditis. Supplementary Figure 1 presents the time course of treatment. High-density areas wtihin the myocardium were initially detected by computed tomography (CT) 10 days after admission which was not observed on admission (Fig. 1A). The CT tissue attenuation value reached 106 Hounsfield Unit (HU) in these areas 40 days after admission (Fig. 1B), with changes in the left lateral wall being more evident than other areas.
Comparison of coronary CT angiography-based and invasive coronary angiography-based quantitative flow ratio for functional assessment of coronary stenosis: A multicenter retrospective analysisThe aim of this study was to evaluate the diagnostic performance of coronary CT angiography (CTA)-based quantitative flow ratio (QFR), namely CT-QFR, and compare it with invasive coronary angiography (ICA)-based Murray law QFR (μQFR), using fractional flow reserve (FFR) as the reference standard.
Multivessel coronary artery aneurysms as a complication of chronic active Epstein-Barr virus infection: An atypical and occasional complicationCoronary artery aneurysm (CAA) is defined as a coronary artery dilatation >1.5 times the diameter of the normal adjacent segments or the diameter of the patient's largest coronary vessel. It is an uncommon disease, present in 1–4% of coronary angiography findings.1
Perivascular fat attenuation for predicting adverse cardiac events in stable patients undergoing invasive coronary angiographyInflammation surrounding the coronary arteries can be non-invasively assessed using pericoronary adipose tissue attenuation (PCAT). While PCAT holds promise for further risk stratification of patients with low coronary artery disease (CAD) prevalence, its value in higher risk populations remains unknown.
Systolic or diastolic CT image acquisition for transcatheter aortic valve replacement – An outcome analysisComputed tomography (CT) imaging is the standard of care before transcatheter aortic valve replacement (TAVR). The aortic annulus undergoes conformational changes during the heart cycle. Therefore, the image acquisition time point can impact prosthesis sizing and fit. Clinical outcome data are lacking. The aim of this study was to compare systolic and diastolic cardiac CT data acquisition with regard to procedural and clinical outcomes in patients undergoing TAVR for severe aortic stenosis (AS).
Coronary CTA plaque volume severity stages according to invasive coronary angiography and FFRAtherosclerotic plaque characterization by coronary computed tomography angiography (CCTA) enables quantification of coronary artery disease (CAD) burden and type, which has been demonstrated as the strongest discriminant of future risk of major adverse cardiac events (MACE). To date, there are no clinically useful thresholds to assist with understanding a patient's disease burden and guide diagnosis and management, as there exists with coronary artery calcium (CAC) scoring. The purpose of this manuscript is to establish clinically relevant plaque stages and thresholds based on evidence from invasive angiographic stenosis (ICA) and fractional flow reserve (FFR) data.
Are risk factors necessary for pretest probability assessment of coronary artery disease? A patient similarity network analysis of the PROMISE trialPretest probability (PTP) calculators utilize epidemiological-level findings to provide patient-level risk assessment of obstructive coronary artery disease (CAD). However, their limited accuracies question whether dissimilarities in risk factors necessarily result in differences in CAD. Using patient similarity network (PSN) analyses, we wished to assess the accuracy of risk factors and imaging markers to identify ≥50% luminal narrowing on coronary CT angiography (CCTA) in stable chest-pain patients.
Prognostic value of computed tomography derived fractional flow reserve for predicting cardiac events and mortality in kidney transplant candidatesCardiac screening using coronary computed tomography angiography (CCTA) in kidney transplant candidates before transplantation yields both diagnostic and prognostic information. Whether CT-derived fractional flow reserve (FFRCT) analysis provides prognostic information is unknown. This study aimed to assess the prognostic value of FFRCT for predicting major adverse cardiac events (MACE) and all-cause mortality in kidney transplant candidates.
Prospective evaluation of the learning curve and diagnostic accuracy for Pre-TAVI cardiac computed tomography analysis by cardiologists in training: The LEARN-CT studyTo investigate the learning curve and the minimum number of cases required for a cardiologist in training to acquire the skills to an accurate pre-TAVI cardiac CT (CCT) analysis using a semi-automatic software.
Diagnostic concordance and discordance between angiography-based quantitative flow ratio and fractional flow reserve derived from computed tomography in complex coronary artery diseaseBoth quantitative flow ratio (QFR) and fractional flow reserve derived from computed tomography (FFRCT) have shown significant correlations with invasive wire-based fractional flow reserve. However, the correlation between QFR and FFRCT is not fully investigated in patients with complex coronary artery disease (CAD). The aim of this study is to investigate the correlation and agreement between QFR and FFRCT in patients with de novo three-vessel disease and/or left main CAD.
Coronary volume to left ventricular mass ratio in patients with diabetes mellitusDiabetes mellitus is a major risk factor for coronary artery disease (CAD) and may provoke structural and functional changes in coronary vasculature. The coronary volume to left ventricular mass (V/M) ratio is a new anatomical parameter capable of revealing a potential physiological imbalance between coronary vasculature and myocardial mass. The aim of this study was to examine the V/M derived from coronary computed tomography angiography (CCTA) in patients with diabetes.
Reproducibility of 4D cardiac computed tomography feature tracking myocardial strain and comparison against speckle-tracking echocardiography in patients with severe aortic stenosisMyocardial strain is an established parameter for the assessment of cardiac function and routinely derived from speckle tracking echocardiography (STE). Novel post-processing tools allow deformation imaging also by 4D cardiac computed tomography angiography (CCT). This retrospective study aims to analyze the reproducibility of CCT strain and compare it to that of STE.
Increased coronary pericoronary adipose tissue attenuation in diabetic patients compared to non-diabetic controls: A propensity score matching analysisPericoronary adipose tissue (PCAT) attenuation is an indicator of active inflammation of perivascular adipose tissue, which is supposed to increase in diabetic patients. We aimed to investigate the PCAT attenuation values and high-risk plaque (HRP) features in diabetic and non-diabetic subjects with different stenotic extents.
IgG4-related disease: Coronary arteritis masquerading as coronary “masses”A 64-year-old man with a history of psoriasis and latent tuberculosis presented to the emergency department with cough and dyspnea. Transthoracic echocardiogram (TTE) showed a large pericardial effusion with early echocardiographic signs of tamponade and a well circumscribed right atrioventricular groove mass extending into the pericardial space, moving with the cardiac cycle without independent mobility (Fig. 1). Pericardiocentesis drained 1 L of sanguinous fluid with a lymphocytic predominance and negative infectious and cytologic work-up.
Live integration of comprehensive cardiac CT with electroanatomical mapping in patients with refractory ventricular tachycardiaAim of the present study was to verify the feasibility and accuracy of live integration of myocardial fibrosis evaluated at CCT with EAM (electro-anatomical mapping).
Deep learning model to quantify left atrium volume on routine non-contrast chest CT and predict adverse outcomesTable of Contents Summary: We aimed to validate a deep learning model to automatically quantify left atrial (LA) volumes from routine non-contrast chest CT and evaluate prediction for cardiovascular outcomes. We evaluated 273 patients (median age 69 years, 55.5% male) who underwent a routine non-ECG gated NCCT for lung cancer screening. LA volumes were quantified by three expert cardiothoracic radiologists and a prototype AI algorithm. There was excellent correlation between AI and expert results. AI-derived LA volumes were associated with increased risk of major adverse cardiac events, heart failure hospitalization, and new-onset atrial fibrillation within five years.
Impact of computed-tomography defined sarcopenia on outcomes of older adults undergoing transcatheter aortic valve implantationThe adoption of Computed tomography (CT)-defined sarcopenia to risk stratify transcatheter aortic valve implantation (TAVI) candidates remains limited by a lack of both standardized definition and evidence of independent value over currently adopted mortality prediction tools.
The impact of hypo-attenuated leaflet thickening on haemodynamic valve deterioration following transcatheter aortic valve replacement186 patients were prospectively recruited following transcatheter aortic valve replacement (TAVR) for hypo-attenuated leaflet thickening (HALT) on computed-tomography (CT) imaging and to determine its impact on haemodynamic valve deterioration (HVD). Routine echocardiograms at discharge, one month and annually were performed. LT prevalence was 17.7% and HVD was present in 8.6% of the total cohort. HALT was the only independent predictor of HVD. Thresholds for HALT predicting HVD were a cumulative depth of 2.4 mm and cumulative area of 28 mm2. HALT is an independent predictor of HVD, which exhibits specific depth and area thresholds for HVD prediction.
Cumulative exposure amount of PM2.5 in the ambient air is associated with coronary atherosclerosis - Serial coronary CT angiography studyTOC SUMMARY: It is unclear how air pollution contributes to the development of cardiovascular disease. We investigated the change of coronary atherosclerosis using serial CCTAs in relation to the cumulative amount of PM2.5 exposure between the two CCTAs in 3,127 healthy adults. Coronary calcification progressed in 1,361 (43.5%) subjects with a positive relationship between the cumulative amount of PM2.5 exposure and CACS. The cumulative amount of PM2.5 exposure, rather than the average concentration of PM2.5, was independently associated with progression of coronary calcification and diffuse development of de novo calcified plaques, with its impact higher than any other traditional cardiovascular risk factors.